Diapositiva 1

1
TECHNICAL CONSULTATION Meeting "Analysis of the
dengue situation in the South American region and
the role of the National Institutes of Health"
Suriname
2
Epidemiological situation of dengue

• Proportion of the territory affected by the
  dengue mostly the capital as around 45 of the
  population resides here/ but rural and interior
  areas show outbreaks too
• Proportion of the territory with the presence of
  vector probably 100 (also in the interior)
• Incidence of severe cases depends on circulating
  types- AND epidemics seem to be cyclical (2000-
  2005- 2009 showed epidemic numbers)
• Death rate varies per year -median 2-3 deaths
  per year
• Epidemic year 2000 16 deaths 0.03/ 1000/ year
• Epidemic year 2005 12 deaths 0.024/ 1000/ year
• Epidemic year 2009 4 deaths 0.008/ 1000/ year
• Serotypes circulating in the country all types,
  have occurred so far- 2010- type 4 was the main
  circulating type

3
Epidemiological situation of dengue

• Main determinants
• Vector areas with a high mosquito index
• Environment areas with water flooding and many
  overgrown terrains and areas with lots of
  garbage in the neighboorhood show more cases
• Season rainy seasons show more cases
• Tourists and migrants from areas with no dengue
  (europe/ china?) are also vulnerable
• East indian people also seem to be somewhat more
  vulnerable compared to creole population
• Occupation schools / workplaces in problem
  areas, though no recent outbreaks reported-
  chinese possible also affected more, due to
  working hours, long opening hours shops?

4
Dengue epidemics often show 2 or more dengue
types occurring concurrently- figure shows
suspect confirmed hospitalized cases 1978-2010
5
Epidemiological situation of dengue

• Main control strategies implemented
• Surveillance
• Outbreak investigation clusters of cases
• Reporting to environmental officers
• Spraying 100 m diameter around outbreaks areas
• (no spraying in schools or areas with high number
  of cases)
• During epidemics
• Incidental collection of bulky waste (old cars/
  broken machines)
• Area wide spraying

6
Higher numbers seen in rainy seasons epidemic
numbers in 2009
7
2009 showed high numbers of hospitalizations in
the small rainy season while dengue type 1 3
were circulating In 2010, dengue type 4 was the
main circulating type
8
Role of National Institute of Health or equivalent

• Laboratory methods available in the country
• PCR/ serology dengue ELisa
• Availability of commercial kits and / or
  in-house
• Rapid tests
• Technical assistance from carec-lab for
  confirmation

9
Role of National Institute of Health or equivalent

• Dengue surveillance system
• 2 levels available
• Primary care
• sentinel surveillance (no testing done only with
  outbreaks)
• Trend analysis
• Secondary care all hospitalized cases
• Usually tests done depending on onset date (PCR
  or serology- Igm)
• DHF and DSS also included

10
Role of National Institute of Health or equivalent

• Surveillance of insecticide resistance
• Not done?

11
Role of National Institute of Health or equivalent

• Main results of research on dengue
• No research done

12
Opportunities and needs for technical cooperation
between institutes / countries

• Intrasectoral cooperation strategies
  evironmental health/ epidemiology? How is this
  done in other countries
• Training studies for improved vector
  surveillance
• Spraying strategies
• Intersectoral cooperation
• Public works MOH (garbage disposal/
  environmental health strategies0
• Information sharing Guyanas and other
  neighbooring countries
• Health education strategies
• Vaccination strategies trials in other
  countries succesful?/ vaccine availability?